[Urachus cystopexy: new technique for bladder suspension associated to the Burch's technique in the treatment of cystocele and stress urinary incontinence. Long-term follow-up].

OBJECTIVES

To compare long term efficacy and morbidity in patients with stress urinary incontinence treated using Burch's colpopexy versus Burch's colpopexy plus urachus-cystopexy.

METHODS

Retrospective, longitudinal comparative, observational study in 129 patients with stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). Fifty four patients underwent Burch's colpopexy (group B) and 75 patients underwent Burch's colpopexy and urachus-cystopexy (group B U). These patients completed inclusion criteria from January 1994 to March 2005. The severity of SUI was evaluated by means of the number of pads used in 24 hours. Cure was defined as patients not using any pad for urinary leakage; improvement, when the number of pads used decreased to one pad a day; and failure when the patients used more than 1 pad in 24 hours. In MUI the urge urinary incontinence (UUI) component was evaluated separately.

RESULTS

After 12 months of follow-up, 47 patients of group B and 67 patients of group BU were evaluated analyzing cure/improvement. Either one were observed in 74.4% (29/6) and 97% (58/7) respectively (p = 0.001). At 24 months follow up, in 35 patients of group B and 42 of group BU, a rate of 65.7% (22/3) and 97.6% (37/4) was observed respectively (p = 0.014). MUI was present in 53.7% of group B and 58.6% patients of group BU. An independent analysis was made on urge urinary incontinence (UUI) in these patients at 12 months; 53.1% of group B and 19.4% of group BU had UUI (p = 0.000). At 24 months, 50% of patients of group B and 26.19% of group BU had UUI (p = 0.029). De novo UUI was present in 19.4% of group B and 5.97% of group BU (p = 0.000) at 12 months follow-up, and in 17.64% of patients of group B and 13.95% of group BU (p = 0.005) at 24 months. Complications related to urachus-cystopexy presented trans-operatively: vesical injury in 3 of the initial cases, solved with bladder closure in two layers and vesical catheter for 7 days approximately.

CONCLUSIONS

Burch's procedure in addition to urachus-cystopexy was better for the treatment of SUI and UUI than Burch's procedure alone in a long term clinical follow-up. Surgical fixation of the urachus to the anterior abdominal wall provides extra support to the bladder and probably reduces its displacement during strength, avoiding tension of urethral and bladder neck fixations and increasing the efficacy of Burch's procedure.